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NPI Code Detail

MEDICARE: JAY DICKINSON MA, LPC

MEDICARE: JAY DICKINSON MA, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YP2500XProfessional CounselorPC004833PA

General Provider Information

NPI Number : 1619095163
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAY DICKINSON MA, LPC
Provider Business Mailing Address
First Line : 255 S 17TH ST STE 1010
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-6210
Country : US
Telephone Number : 610-892-3800
Fax Number : 484-468-1412
Provider Business Practice Location Address
First Line : 255 S 17TH ST STE 1010
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-6210
Country : US
Telephone Number : 610-892-3800
Fax Number : 484-468-1412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 11/02/2024

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